Collecting portoenterostomy; is it a salvage or definitive procedure? Report of 17 cases and a review of its merits and limitations

Abstract

Background: Portoenterostomy (PE) is the standard treatment for biliary atresia. Besides this purpose studies about indications for its usage is very limited. Material and Methods: We discussed the clinical data of our patients who had undergone aggressive biliary tract resection and collecting portoenterostomy (CPE) for biliary tract trauma, hilar cholangiocarcinoma and bening biliary tract stenosis in the light of the current literature. 17 patients were enrolled in the last 4 years. 5 of them are female, 12 of them are male and mean age is 67.7 years (range; 43-86 years). CPE were performed in the patient who has 3 or more bile duct terminal after hilar resection for tumor (Figure 1ab) or including major bile duct injury. Results: Complet resection of stricture dbile duct region and CPE was performed in two patients who had anastomotic stricture following hepaticojejunostomy. Two patient had post-traumatic stenosis and also hepatolithiasis. Ten of the 11 patients who hasmalign pathologies were Klatskin tumor and one had invasive gallbladder cancer. Five of the patients with a tumor had microscopic (R1) tumor in proximal surgical margin. Mortality among CPE performed patients are none in trauma and bening pathology patients; but in tumor group one patient died because of post-op hemorrhage on day two, two patients died for pulmonary complications on third month and three patients died on 9th, 11th and 17th post-op month due to tumor recurrence and metastasis. Discussion and Conclusion: CPE can be the definitive treatment for biliary tract trauma, bening biliary strictures and chosen hepatolithiasis cases related with biliary strictures (Figure 1cd). CPE can be usedin selected patients with negative surgical margin (R0), microscopically positive surgical margin (R1) in biopsy samples and high co-morbid biliary tract carcinomas. In order to understand the efficacy of CPE for hilar carcinomas need to be more clinical studies.